Surveillance of Terminal Deoxynucleotidyl Transferase-Positive Cells in Peripheral Blood of Patients with Acute Lymphoblastic Leukemia
Although 95% of children and 80% of adults with acute lymphoblastic leukemia (ALL) can be expected to achieve complete remission with modern therapy, 40–50% of children and 70–80% of adults will eventually succumb to recurrent disease. Many children with ALL who are cured face an uncertain risk of impaired intellectual function, neuroendocrine abnormalities, decreased reproductive capacity, and second neoplasms such as brain tumors. A current dilemma is how to intensify therapy for the high-risk patient without simultaneously exposing all patients to excessive hazards of treatment. Part of this problem stems from the inaccuracy of risk prediction. The availability of sensitive assays for minimal residual disease would add great precision to risk assignment and permit intensified therapy to be aimed at those patients who need it most. Patients whose disease is under control could be spared unnecessary toxicity. If successful, this type of surveillance could become an important tool in selecting alternate chemotherapy at an earlier point in time than is now possible and could serve as a guide to the most effective form of alternate therapy. Sensitive detection of minimal residual leukemia is needed to quantitate tumor cells in bone marrow before and after purging in order to distinguish between inadequate marrow purging and suboptimal ablative therapy as causes of failure in autologous bone marrow transplantation programs.
KeywordsAcute Lymphoblastic Leukemia Minimal Residual Disease Lymphoblastic Lymphoma Pediatric Oncology Group Pheral Blood
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